先天性心脏病改良Blalock-Taussig分流术管道闭塞患儿血小板参数及凝血功能变化及意义
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摘要
目的探讨血小板参数及凝血功能的变化情况在先天性心脏病患儿改良Blalock-Taussig(BT)分流术管道闭塞中的意义。方法先天性心脏病行改良BT分流手术患儿579例,根据BT管道是否闭塞分为管道闭塞组18例和管道非闭塞组561例。测定2组患儿血小板参数和凝血功能指标。结果管道闭塞组血小板分布宽度[(21.03±6.37)%]、平均血小板体积[(15.12±6.59)fL]以及纤维蛋白原[(4.29±0.78)g/L]、D-二聚体水平[(0.57±0.21)mg/L]均高于管道非闭塞组[(14.95±2.14)%、(8.03±3.17)fL、(3.34±0.85)g/L、(0.24±0.15)mg/L](P<0.05),2组血小板计数、血小板压积、凝血酶原时间、凝血酶时间、活化部分凝血活酶时间比较差异均无统计学意义(P>0.05)。结论血小板分布宽度、平均血小板体积、纤维蛋白原、D-二聚体水平升高可增加先天性心脏病改良BT术患儿BT管道闭塞风险。
Objective To investigate the significance of the changes of platelet parameters and coagulation function in congenital heart disease children with modified Blalock-Taussig(BT)shunt obstruction.Methods Totally 579 children with congenital heart disease underwent modified BT shunt and were divided into BT obstruction group(n=18)and BT non-obstruction group(n=561).The platelet parameters and coagulation parameters were detected in two groups.Results The platelet distribution width((21.03±6.37)%),mean platelet volume((15.12±6.59)fL),fibrinogen((4.29±0.78)g/L)and D-dimer level((0.57±0.21)mg/L)in BT obstruction group were significantly higher than those in BT non-obstruction group((14.95±2.14)%,(8.03±3.17)fL,(3.34±0.85)g/L,(0.24±0.15)mg/L)(P<0.05),and there were no significant differences in the platelet count,thrombocytocrit,prothrombin time,thrombin time and activated partial thromboplastin time between two groups(P>0.05).Conclusion The elevated levels of platelet distribution width,mean platelet volume,fibrinogen and D-dimer can increase the risk for modified BT shunt obstruction in children with congenital heart disease.
Objective To investigate the significance of the changes of platelet parameters and coagulation function in congenital heart disease children with modified Blalock-Taussig(BT)shunt obstruction.Methods Totally 579 children with congenital heart disease underwent modified BT shunt and were divided into BT obstruction group(n=18)and BT non-obstruction group(n=561).The platelet parameters and coagulation parameters were detected in two groups.Results The platelet distribution width((21.03±6.37)%),mean platelet volume((15.12±6.59)fL),fibrinogen((4.29±0.78)g/L)and D-dimer level((0.57±0.21)mg/L)in BT obstruction group were significantly higher than those in BT non-obstruction group((14.95±2.14)%,(8.03±3.17)fL,(3.34±0.85)g/L,(0.24±0.15)mg/L)(P<0.05),and there were no significant differences in the platelet count,thrombocytocrit,prothrombin time,thrombin time and activated partial thromboplastin time between two groups(P>0.05).Conclusion The elevated levels of platelet distribution width,mean platelet volume,fibrinogen and D-dimer can increase the risk for modified BT shunt obstruction in children with congenital heart disease.
引文
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[2]QUANDT D,RAMCHANDANI B,STICKLEY J,et al.Stenting of the right ventricular outflow tract promotes better pulmonary arterial growth compared with modified BlalockTaussig shunt palliation in tetralogy of Fallot-type lesions[J].JACC Cardiovasc Interv,2017,10(17):1774-1784.
[3]杨美荣,张国顺,刘斌,等.肝硬化患者血小板参数和凝血指标水平变化及意义[J].中华实用诊断与治疗杂志,2016,30(10):977-979.
[4]HOLTBY H M.Anesthetic considerations for neonates undergoing modified Blalock-Taussig shunt and variations[J].Paediatr Anaesth,2014,24(1):114-119.
[5]GLATZ A C,PETIT C J,GOLDSTEIN B H,et al.Comparison between patent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductaldependent pulmonary blood flow:insights from the congenital catheterization research collaborative[J].Circulation,2018,137(6):589-601.
[6]樊星,张宏家,刘迎龙,等.发绀型复杂先天性心脏病患儿姑息术后血气与血流动力学变化研究[J].中华实用诊断与治疗杂志,2014,28(4):342-345.
[7]张雅娉,朱耀斌,杨尧,等.血小板容积与先天性心脏病改良BT管道闭塞关系的研究[J].心肺血管病杂志,2016,35(2):120-123.
[8]ULUCAN S,KESER A,KAYA Z,et al.Association between PDW and long-term major adverse cardiac events in patients with acute coronary syndrome[J].Heart Lung Circ,2016,25(1):29-34.
[9]崔巍,贾秋蕾,胡元会,等.血小板微粒膜表面功能蛋白与不稳定型心绞痛相关性[J].中华实用诊断与治疗杂志,2017,31(6):550-553.
[10]ESER C,ESER S,GENCEL E,et al.Is the preoperative MPV value related to early thrombus formation in microvascular anastomosis?[J].J Plast Surg Hand Surg,2016,50(5):298-301.
[11]周跟东,张晓红,班向阳,等.血栓抽吸在急性心肌梗死患者急诊经皮冠状动脉介入治疗中应用价值[J].中华实用诊断与治疗杂志,2017,31(2):159-161.
[12]PRASAD J M,GORKUN O V,RAGHU H,et al.Mice expressing a mutant form of fibrinogen that cannot support fibrin formation exhibit compromised antimicrobial host defense[J].Blood,2015,126(17):204720-204758.
[13]MURUGESAN V,PULIMAMIDI V K,RAJAPPA M,et al.Elevated fibrinogen and lowered homocysteine-vitamin determinants and their association with left atrial thrombus in patients with rheumatic mitral stenosis[J].Br J Biomed Sci,2015,72(3):102-106.
[14]SUNNETCIOGLU A,SERTOGULLARINDAN B,OZBAY B,et al.Assessments of the associations of thrombus localization with accompanying disorders,risk factors,D-dimer levels,and the red cell distribution width in pulmonary embolism[J].Clinics(Sao Paulo),2015,70(6):441-445.
[15]SARTORI M,MIGLIACCIO L,FAVARETTO E,et al.Ddimerfor the diagnosis of upper extremity deep and superficial venous thrombosis[J].Thromb Res,2015,135(4):673-678.